I am  really, really tired of the assumption that NICU doctors, nurses,
nutritionists,  etc. either don't know about risks to infants or don't care!  This
is simply not true and incredibly unfair.  Preterm infants are not normal,
were never meant to survive, and you cannot apply rules for full-term infants
to  their care.  EVERYTHING we do in the NICU to save infants' live incurs
risk.  We are constantly balancing the risk of any
treatment/medication/procedure against the risk of NOT doing it.

The very  ventilators and oxygen we use to save lives cause damage to lungs
and  eyes.  Similarly, fortifiers we use to save brains and other organs, have
risks as well.  Powdered follow-up formulas are used for healthy growing
premature infants to provide the appropriate levels of nutrients for their stage
of development.  We do not, at this point, have other alternatives with
proven safety and efficacy.

In 30 years  in the NICU, and hundreds of thousands of infants cared for, I
have yet to see a  case of enterbacter sakazakii sepsis from powdered formula.
Does it  happen? - yes.  Are their babies who die from group B streptococcus
in  mother's breastmilk?-yes  Does it happen in Norway? - yes.

We are  constantly looking for and testing other ways to improve ALL we do in
the  NICU.  We all want the best outcomes, including nutritional outcomes,
for  our infants, and spend an incredible number of unpaid hours in continuous
quality improvement efforts like VON, iNICQ, CPQCC, writing articles and
books.  I am very disappointed at some of the cavalier statements on  LACTNET by
otherwise intelligent, responsible people.

Nancy
Nancy E. Wight MD, IBCLC, FABM,  FAAP
Neonatologist
Sharp Mary Birch Hospital for Women and Rady Children's  Hospital San Diego
Medical Director, Sharp HealthCare Lactation  Services
San Diego, CA
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